According to the Centers for Disease Control and Prevention (CDC), in 2023, 9.8% of Zambia’s population ages 15 to 49 was living with HIV, with about 15,000 related deaths recorded that same year. Based on the distribution of HIV across the population, the United Nations Children’s Fund (UNICEF) classifies Zambia as having a generalized HIV epidemic. HIV epidemics are considered “generalized” when transmission occurs largely through sexual activity in the general population, meaning programs that focus only on specific vulnerable groups are unlikely to significantly reduce overall transmission or achieve eradication.

In Zambia, several nongovernmental organizations (NGOs) have worked to reduce the impact of the HIV epidemic. These include the Elizabeth Glaser Pediatric AIDS Foundation and FHI 360. One of these organizations was Project HOPE, a global health and humanitarian organization operating across five continents with a mission to improve access to care and health outcomes worldwide. Project HOPE has operated in Zambia since 2019, focusing on reducing the effects of the HIV epidemic, particularly among children and adolescents.

Project HOPE’s Efforts in Zambia

Because Zambia is experiencing a generalized epidemic, HIV transmission occurs primarily through unprotected sexual activity. However, there is a significant disparity between young men and women ages 15 to 24. In 2020, HIV prevalence among young women was 5.7%, compared with 1.8% among young men. This disparity may be linked to factors such as high rates of early pregnancy, earlier sexual debut, coercion linked to unequal power dynamics and age-disparate sexual relationships, all of which are prevalent among adolescent girls and young women in Zambia.

Project HOPE identified these dynamics as a major concern and focused its work on addressing the underlying socioeconomic factors that influence HIV transmission among adolescents and young adults.

On the ground, Project HOPE supported HIV treatment efforts by helping ensure access to pre-exposure prophylaxis (PrEP), counseling adolescents and young people on positive sexual health practices and supporting HIV health informatics programs. The organization also partnered with the Centre for Infectious Disease Research in Zambia to support the Empowered Children and Adolescents Project through community interventions and case management.

Through these efforts, Project HOPE provided antiretroviral therapy to 388,836 adults and children living with HIV and delivered gender-based violence education to 2,565 individuals. On Sept. 8, 2025, Project HOPE announced that it had ended operations in Zambia as of June 2025. The organization cited reductions in U.S. foreign assistance funding following a realignment of foreign aid policy as the primary reason for the decision.

The America First Global Health Strategy

The America First Global Health Strategy was introduced by the U.S. Department of State in September 2025. The strategy responded to concerns about inefficiencies in global health foreign assistance programs. According to the Department of State, only about 40% of global health aid reached frontline workers and commodities, while 60% supported technical assistance, program management and other overhead costs.

Officials attributed this imbalance to earlier policies that emphasized direct investment through NGOs, which they said created parallel supply chains and procurement systems alongside local governments.

As a result, the policy shift led to significant reductions in U.S. Agency for International Development funding for NGOs, with a greater emphasis on delivering aid through local governments. The stated goal is to strengthen public health systems and build long-term self-sufficiency in responding to crises such as the HIV epidemic.

The Role of NGOs in Zambia

As the America First Global Health Strategy takes shape, organizations such as Project HOPE have struggled to sustain operations in countries like Zambia. However, Steven Neri, Project HOPE’s senior regional director for Africa, emphasized the continued importance of NGOs when speaking with The Borgen Project.

“Project HOPE was able to bring our expertise from across Africa and around the world to support the HIV prevention, care and treatment program in Zambia,” Neri said. “Our ability to bring lessons from outside Zambia and work with Zambians to translate those lessons into effective HIV programs is something that I am proud of.”

Neri also highlighted the role of the President’s Emergency Plan for AIDS Relief (PEPFAR), which has invested more than $110 billion in HIV programs globally, in advancing innovation and expertise in HIV management.

The Future of HIV Management in Zambia

Although Project HOPE has concluded its operations in Zambia, HIV epidemic management continues through coordination between the U.S. and Zambian governments. On Nov. 18, 2025, the Department of State announced that the first doses of lenacapavir had been delivered to Zambia.

Lenacapavir is a twice-yearly injectable PrEP medication that offers a long-acting alternative to daily oral pills, particularly for individuals who face challenges with adherence or access to health care. On Nov. 4, 2025, after 12 working days of review, both tablet and injectable forms of lenacapavir received approval for HIV prevention from the Zambia Medicines Regulatory Authority.

As U.S. funding shifts away from NGOs and places greater responsibility on local governments, Project HOPE has emphasized the importance of retaining proven best practices during this transition. Neri expressed cautious optimism about the future of HIV management in Zambia while stressing the need for continued support for on-the-ground delivery.

“Making lenacapavir available in Zambia is consistent with the original focus of PEPFAR,” Neri said. “Without medicines, it is impossible to have a successful HIV program, and without program funding, it is hard to imagine how access to medicines will improve. The two go hand in hand.”

– Nikhil Kumar

Nikhil is based in Lexington, MA, USA and focuses on Global Health and Politics for The Borgen Project.

Photo: Flickr